WO2017208399A1 - Outil de traitement - Google Patents

Outil de traitement Download PDF

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Publication number
WO2017208399A1
WO2017208399A1 PCT/JP2016/066261 JP2016066261W WO2017208399A1 WO 2017208399 A1 WO2017208399 A1 WO 2017208399A1 JP 2016066261 W JP2016066261 W JP 2016066261W WO 2017208399 A1 WO2017208399 A1 WO 2017208399A1
Authority
WO
WIPO (PCT)
Prior art keywords
rotation axis
housing
predetermined rotation
rotating member
protrusion
Prior art date
Application number
PCT/JP2016/066261
Other languages
English (en)
Japanese (ja)
Inventor
央士朗 北村
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2016/066261 priority Critical patent/WO2017208399A1/fr
Publication of WO2017208399A1 publication Critical patent/WO2017208399A1/fr
Priority to US16/196,977 priority patent/US20190083119A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0042—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping
    • A61B2017/00424—Surgical instruments, devices or methods, e.g. tourniquets with special provisions for gripping ergonomic, e.g. fitting in fist
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2902—Details of shaft characterized by features of the actuating rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320071—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with articulating means for working tip
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320072—Working tips with special features, e.g. extending parts
    • A61B2017/320078—Tissue manipulating surface

Definitions

  • the present invention relates to a treatment tool for treating a treatment target with an end effector.
  • US Pat. No. 5,383,888 discloses a treatment instrument in which an end effector for treating a treatment target is provided at the tip of a shaft.
  • a shaft is connected to a holdable housing, and the handle is opened or closed with respect to the grip of the housing, whereby the end effector opens or closes between a pair of gripping pieces.
  • a rotating member (rotating knob) is attached to the housing so as to be rotatable about the central axis of the shaft.
  • the shaft and the end effector rotate with respect to the housing together with the rotating member, with the central axis of the shaft as a predetermined rotation axis.
  • the angular position of the end effector about the predetermined rotation axis changes.
  • the end effector bends with respect to the shaft (the central axis of the shaft) based on an operation at a bending operation portion (wing member) provided in the housing.
  • treatment is performed with the end effector bent with respect to the shaft, or treatment is performed with the end effector open between a pair of gripping pieces.
  • a force may act on the end effector at a position away from the central axis of the shaft.
  • the force acting on the end effector generates a rotational moment around the central axis of the shaft, and the shaft may rotate together with the end effector. For example, if the shaft and the end effector rotate together as described above in a state in which the treatment target is grasped between the grasping pieces, the treatment may be affected.
  • the present invention has been made to solve the above-described problems, and an object of the present invention is to provide a treatment instrument in which rotation of an end effector and a shaft due to force acting on the end effector is effectively prevented. It is in.
  • a treatment instrument includes a housing that can be held, a shaft that can rotate around a predetermined rotation axis with respect to the housing, and an end that is provided at the tip of the shaft.
  • An effector a rotating member that rotates about the predetermined rotation axis together with the shaft and the end effector, a protrusion that protrudes to the outer peripheral side of the rotating member, and extends from the proximal end side to the distal end side, and the rotation A recess that is continuous to the tip side of the projection in the member or provided on the tip side of the projection in the housing and is recessed on the inner peripheral side.
  • FIG. 1 is a schematic view of the treatment tool according to the first embodiment viewed from one side in the width direction of the housing.
  • FIG. 2 is a schematic view of the treatment instrument according to the first embodiment viewed from the side opposite to the side where the grip is located with respect to a predetermined rotation axis.
  • FIG. 3 is a schematic view of the rotating member according to the first embodiment viewed from the proximal end side.
  • FIG. 4 is a cross-sectional view showing the rotary member according to the first embodiment in a cross section substantially perpendicular to a predetermined rotation axis.
  • FIG. 5 is a cross-sectional view showing a VV cross section of FIG. 6 is a cross-sectional view showing a cross section taken along line VI-VI in FIG. FIG.
  • FIG. 7 is a schematic view of a state in which the housing according to the first embodiment is held with one hand, as viewed from one side in the width direction of the housing.
  • FIG. 8 is a cross-sectional view showing the rotating member in a state in which the index finger is in contact with the rotating member, in a section substantially parallel to a predetermined rotation axis.
  • FIG. 9 is a perspective view schematically showing the treatment tool according to the first modification.
  • FIG. 10 is a perspective view schematically showing a state in which the housing of the treatment instrument according to the first modification is held with one hand.
  • FIG. 11 is a schematic diagram illustrating the configuration of the distal end portion of the treatment tool according to the second modification.
  • FIG. 12 is a schematic diagram illustrating the configuration of the distal end portion of the treatment tool according to the third modification.
  • FIG. 13 is a schematic diagram illustrating a configuration of a distal end portion of a treatment tool according to a fourth modification.
  • FIGS. 1 and FIG.2 is a figure which shows the treatment tool (gripping treatment tool) 1 of this embodiment.
  • the treatment instrument 1 has a longitudinal axis C.
  • one side in the direction along the longitudinal axis C is defined as the distal end side (arrow C1 side)
  • the opposite side to the distal end side is defined as the proximal end side (arrow C2 side).
  • the treatment instrument 1 includes a housing 2 that can be held, a shaft (sheath) 3 connected to the distal end side of the housing 2, and an end effector 5 provided at the distal end portion of the shaft 3.
  • the shaft 3 extends from the proximal end side to the distal end side along the longitudinal axis C, and the central axis of the shaft 3 is substantially coaxial with the longitudinal axis C.
  • the side toward the housing 2 is the proximal end side
  • the side toward the end effector 5 is the distal end side.
  • the shaft 3 is rotatable with respect to the housing 2 around the central axis. That is, the central axis of the shaft 3 is a predetermined rotation axis R of the rotation of the shaft 3 with respect to the housing 2.
  • the housing 2 includes a housing main body 11 extending along the longitudinal axis C (predetermined rotation axis R of the shaft 3) and a direction intersecting the predetermined rotation axis R from the housing main body 11 (arrows Y1 and Y2). And a grip (fixed handle) 12 extending along the direction indicated by.
  • the grip 12 is provided at a site away from a predetermined rotation axis R (longitudinal axis C).
  • One end of a cable 13 is connected to the grip 12.
  • the other end of the cable 13 is connected to an energy control device (not shown).
  • FIG. 1 is a view of the treatment instrument 1 as viewed from one side in the width direction of the housing 2 (arrow W1 side).
  • FIG. 2 is a view of the treatment instrument 1 as viewed from the side opposite to the side where the grip 12 is located with respect to the predetermined rotation axis R (longitudinal axis C).
  • the end effector 5 can rotate with respect to the housing 2 around the predetermined rotation axis R together with the shaft 3 and bendable with respect to the shaft 3 (predetermined rotation axis R). As the end effector 5 rotates, the angular position of the end effector 5 around a predetermined rotation axis R changes. Further, the bending direction of the end effector 5 (directions indicated by arrows B1 and B2) intersects with a predetermined rotation axis R (substantially perpendicular).
  • the end effector 5 includes a relay member 15, a first grip piece 16, and a second grip piece 17.
  • the relay member 15 is attached to the tip of the shaft 3 so as to be bent with respect to the shaft 3. That is, a bending joint 18 is formed between the shaft 3 and the relay member 15.
  • the end effector 5 can be opened and closed between the pair of gripping pieces 16 and 17.
  • the opening / closing directions of the gripping pieces 16 and 17 (directions indicated by arrows X1 and X2) intersect with a predetermined rotation axis R and intersect with the bending direction of the end effector 5.
  • one of the grip pieces 16 and 17 is integrated with the relay member 15 or fixed to the relay member 15, and the other is attached to the relay member 15 so as to be rotatable.
  • both the grip pieces 16 and 17 are rotatably attached to the relay member 15.
  • a rod member extends from the inside of the relay member 15 toward the distal end side, and the gripping pieces 16, 17 are formed by the protruding portion of the rod member from the relay member 15 toward the distal end side. One of these is formed.
  • the other of the grip pieces 16 and 17 is attached to the relay member 15 so as to be rotatable.
  • a handle (movable handle) 21 is rotatably attached to the housing 2.
  • the handle 21 is opened or closed with respect to the grip 12. That is, the handle 21 can be opened and closed with respect to the grip 12.
  • the handle 21 includes a force application unit 22 to which an operation force for opening or closing the handle 21 with respect to the grip 12 is applied.
  • the force application unit 22 is located on the side where the grip 12 is located with respect to the predetermined rotation axis R (longitudinal axis C) and at the tip with respect to the grip 12. Located on the side.
  • the movement direction of the handle 21 in the opening operation and the closing operation with respect to the grip 12 is substantially parallel to the longitudinal axis C.
  • a movable member (not shown) that extends inside the shaft 3 is applied to the shaft 3 and the housing 2. It moves along the longitudinal axis C (predetermined rotation axis R). Accordingly, at least one of the gripping pieces 16 and 17 rotates with respect to the relay member 15, and the space between the gripping pieces 16 and 17 is opened or closed.
  • a bending dial 23 is attached to the housing 2 as a bending operation input portion.
  • a bending dial (bending operation input unit) 23 performs an operation input such as turning the bending dial 23
  • a bending wire (not shown) extending inside the shaft 3 is connected to the shaft 3 and the housing 2.
  • the bending dial 23 may be rotatable about a predetermined rotation axis R with respect to the housing 2 together with the shaft 3 and the end effector 5, and may be rotated about the rotation axis R together with the shaft 3 and the end effector 5. It does not have to rotate.
  • the bending dial 23 is attached to the base end surface of the housing main body 11, but the position of the bending dial 23 is not limited to this.
  • a bending operation input unit such as a bending dial (23) is attached to the outer surface of the housing body 11 facing the side opposite to the side where the grip 12 is located with respect to a predetermined rotation axis R (longitudinal axis C). Also good.
  • a rotating member (rotating knob) 25 is attached to the front end side of the housing body 11.
  • the shaft 3 is attached to the housing 2 in a state where the shaft 3 is inserted into the rotating member 25 and the housing main body 11 from the distal end side.
  • the rotating member 25 is fixed to the shaft 3 and rotates around the predetermined rotation axis R with respect to the housing 2 together with the shaft 3 and the end effector 5.
  • an operation force that rotates the shaft 3 and the end effector 5 around a predetermined rotation axis R is applied to the rotation member 25 that is a rotation operation input unit.
  • the operation buttons 27A and 27B are attached to the housing 2. Each of the operation buttons 27A and 27B is pressed to input an operation. On the outer surface of the housing 2, an installation surface 28 facing the distal end side is provided at a position between the force applying unit 22 of the handle 21 and the rotating member 25. The operation buttons 27A and 27B are attached to the installation surface 28. Therefore, each of the operation buttons 27A and 27B has a smaller distance from the predetermined rotation axis R (longitudinal axis C) than the force application unit 22 of the handle 21 (that is, close to the predetermined rotation axis R). .
  • one of the operation buttons 27 ⁇ / b> A and 27 ⁇ / b> B may be provided not on the installation surface 28 but on a portion facing the one side in the width direction on the outer surface of the housing 2. Also in this case, each of the operation buttons 27 ⁇ / b> A and 27 ⁇ / b> B has a smaller distance from the predetermined rotation axis R than the force application unit 22 of the handle 21.
  • the treatment instrument 1 When an operation input is performed with each of the operation buttons 27A and 27B, the treatment instrument 1 is operated in a predetermined operation mode. At this time, for example, in the same manner as a known treatment instrument, any one of high-frequency current, ultrasonic vibration, and heater heat is applied as treatment energy to the treatment object grasped between the grasping pieces 16 and 17.
  • the electric motor when the treatment instrument 1 is operated in a predetermined operation mode based on an operation input of any one of the operation buttons 27A and 27B, the electric motor is driven, so that the gripping pieces 16 and 17 are moved. Staples may be punctured into the treatment target to be grasped.
  • FIG. 3 to 6 are views showing the configuration of the rotating member 25.
  • FIG. 3 is a view of the rotating member (rotating knob) 25 as viewed from the base end side (arrow C2 side)
  • FIG. 4 is a cross section that is substantially perpendicular to (intersects) a predetermined rotation axis R of the rotating member 25.
  • FIG. 5 shows a cross section taken along line VV in FIG. 3
  • FIG. 6 shows a cross section taken along line VI-VI in FIG.
  • an engagement protrusion 31 that protrudes toward the outer peripheral side is formed at the base end portion of the outer peripheral surface of the rotating member 25.
  • the engagement protrusion 31 extends around the entire circumference of the predetermined rotation axis R.
  • An engagement recess 32 that is recessed toward the outer peripheral side is formed at the tip of the inner peripheral surface of the housing body 11.
  • the engaging recess 32 extends over the entire circumference around the predetermined rotation axis R.
  • the proximal end portion of the rotation member 25 is inserted into the housing body 11, and the engagement protrusion 31 engages with the engagement recess 32.
  • the engagement protrusion 31 can move around a predetermined rotation axis R in the engagement recess 32.
  • the outer peripheral surface of the rotating member 25 is provided with (eight in the present embodiment) protrusions 35 and (eight in the present embodiment) recesses 36.
  • Each of the protrusions 35 protrudes to the outer peripheral side of an arbitrary reference surface of the rotating member 25, and each of the concave portions 36 is recessed to the inner peripheral side of the reference surface of the rotating member 25.
  • the protrusion 35 and the recess 36 are located on the distal end side with respect to the engagement protrusion 31 and are exposed to the outside.
  • the plurality of protrusions 35 are provided apart from each other about a predetermined rotation axis R (around the longitudinal axis C).
  • the plurality of recesses 36 are provided apart from each other about a predetermined rotation axis R.
  • Each of the protrusions 35 extends from the proximal end side to the distal end side.
  • the number of protrusions 35 and the number of recesses 36 are the same.
  • Each of the recesses 36 is continuous with a corresponding one tip side in the protrusion 35. For this reason, one concave portion 36 is continuous with each tip side of the protrusion 35.
  • the plurality of protrusions 35 are preferably arranged symmetrically about a predetermined rotation axis R (longitudinal axis C).
  • the plurality of recesses 36 are preferably arranged symmetrically about a predetermined rotation axis R.
  • the protrusions 35 are arranged at substantially equal intervals around the predetermined rotation axis R.
  • the recesses 36 are also arranged at substantially equal intervals around the predetermined rotation axis R.
  • each of the recesses 36 is formed in a shape in which the index finger of the index finger is fitted.
  • FIG. 4 shows a cross section substantially perpendicular to the predetermined rotation axis R that passes through the recess 36.
  • FIG. 5 also shows a longitudinal axis C passing through a protrusion (one of 35) and a recess (corresponding one of 36) continuous to the tip side of the protrusion (one of 35). A parallel section is shown.
  • Each of the protrusions 35 has a protruding end (T1) and a root (Q1).
  • the distance from the predetermined rotation axis R is maximum at the protruding end (T1), and the distance from the predetermined rotation axis R is minimum at the root (Q1).
  • a defining surface 41 that defines the root (Q1) of the protrusion 35 is provided on the outer peripheral surface of the rotating member 25. The regulation surface 41 is exposed to the outside.
  • the defining surface 41 is centered on the predetermined rotation axis R when viewed from the direction along the predetermined rotation axis R (the front end side and the base end side) (in a cross section perpendicular to the predetermined rotation axis R).
  • the defining surface 41 extends at least in a range extending from the proximal end of the protrusion 35 to the distal end of the recess 36 in the direction along the predetermined rotation axis R (longitudinal axis C).
  • the defining surface 41 extends smoothly with no step in the radial direction from the proximal end to the distal end.
  • the distance (D0) in the radial direction from the predetermined rotation axis R is substantially uniform from the proximal end to the distal end of the defining surface 41.
  • a distance changing portion is formed on the defining surface 41 so that the distance (D0) in the radial direction from the predetermined rotation axis R gradually decreases from the proximal end side toward the distal end side. .
  • each of the protrusions 35 protrudes to the outer peripheral side with respect to the defining surface 41.
  • each of the protrusions 35 has a valley (indented toward the inner peripheral side) between a protrusion (one corresponding to 35) adjacent to one side (arrow R1 side) around a predetermined rotation axis R. 42 corresponding ones). That is, in the cross section substantially perpendicular to the predetermined rotation axis R passing through the protrusion 35, the protrusions 35 and the valleys 42 are alternately arranged around the predetermined rotation axis R (around the longitudinal axis C).
  • the trough 42 is defined by the defining surface 41.
  • each of the concave portions 36 is recessed toward the inner peripheral side with respect to the specified surface 41.
  • Each of the recesses 36 opens toward the outer peripheral side at the defining surface 41, and each opening edge (Q 2) of the recess 36 is formed by the defining surface 41.
  • each of the recesses 36 is provided adjacent to one side (arrow R1 side) around the predetermined rotation axis R and protrudes toward the outer peripheral side between the recesses (one corresponding to 36). Corresponding one).
  • the recesses 36 and the protrusions 43 are alternately arranged around the predetermined rotation axis R (around the longitudinal axis C).
  • the convex portion 43 is defined by the defining surface 41.
  • each of the recesses 36 is continuous with the corresponding one tip side of the protrusion 35.
  • each of the convex portions 43 continues to one corresponding tip end side in the valley portion 42.
  • each of the convex portions 43 protrudes on the outer peripheral side with respect to the concave portion 36, but is positioned on the inner peripheral side with respect to the protrusion 35.
  • FIG. 6 shows a longitudinal axis passing through a certain valley (one of 42) and a convex part (one corresponding to 43) continuous to the tip side of the valley (one of 42). A cross section substantially parallel to C is shown.
  • the defining surface 41 does not need to be formed in an arcuate curved surface centered on the predetermined rotation axis R when viewed from the direction along the predetermined rotation axis R.
  • the defining surface 41 is flat. It may be formed. In this case, however, the defining surface 41 defines the root (Q1) of the protrusion 35 and the opening edge (Q2) of the recess 36.
  • each of the protrusions 35 protrudes toward the outer peripheral side with respect to the defining surface 41.
  • Each of the recesses 36 is continuous with the corresponding one end side of the protrusion 35 and is recessed toward the inner peripheral side with respect to the defining surface 41. Therefore, a step (corresponding one of 38) is formed in the radial direction between each of the protrusions 35 and a recess (corresponding one of 36) continuous on the tip side.
  • Each of the steps 38 is larger than the step in the radial direction between each of the protrusions 35 and the corresponding trough (any one of 42).
  • Each step 38 includes a first inclined surface (one corresponding 45) and a second inclined surface (one corresponding 46).
  • Each of the first inclined surfaces 45 extends from the distal end portion of the corresponding projection (corresponding one of 36) toward the distal end side.
  • each of the second inclined surfaces 46 is continuous with the distal end side of the corresponding first inclined surface (corresponding one of 45), and goes to the distal end side to the corresponding concave portion (corresponding one of 36). Extended.
  • each of the 1st inclined surface 45 and the 2nd inclined surface 46 inclines in the state which goes to an inner peripheral side as it goes to a front end side from a base end side.
  • each of the first inclined surfaces 45 and the second inclined surface 46 the distance from the predetermined rotation axis R becomes smaller toward the tip side.
  • Each of the first inclined surfaces 45 is inclined at a first inclination angle (acute angle) ⁇ 1 with respect to a predetermined rotation axis R
  • each of the second inclined surfaces 46 is at a first angle with respect to the predetermined rotation axis R. It inclines with the 2nd inclination angle (acute angle) (alpha) 2 larger than 1 inclination angle (alpha) 1. For this reason, the inclination at each of the second inclined surfaces 46 is larger than the inclination at each of the first inclined surfaces 45.
  • the engaging recess 32 of the housing 2 is provided with a first facing surface 47 facing the front end side.
  • the first facing surface 47 faces the engaging protrusion 31 of the rotating member 25.
  • the engaging protrusion 31 of the rotating member 25 is provided with a second facing surface 48 that faces the first facing surface 47.
  • the second facing surface 48 faces the proximal end side.
  • the first facing surface 47 of the housing 2 faces one side in the width direction (for example, the arrow W1 side), and the second facing surface 48 of the rotating member 25 faces the first facing surface 47. It may be provided in the state to do. In this case, when the force is applied to the rotation member 25 in the width direction of the housing 2 (directions of the arrows W1 and W2), the rotation member 25 slightly moves relative to the housing 2 in the width direction of the housing 2. As a result, the second facing surface 48 comes into contact with the first facing surface 47.
  • the operation and effect of the treatment tool 1 of the present embodiment will be described.
  • the operator holds the housing 2 with one hand (left hand or right hand) and inserts the end effector 5 into a body cavity such as the abdominal cavity.
  • the shaft 3 and the end effector 5 are rotated around a predetermined rotation axis R by rotating the rotating member 25, or the end effector 5 is bent with respect to the shaft 3 by an operation with the bending dial 23, The position and posture of the end effector 5 are adjusted in the body cavity.
  • steering-wheel 21 is closed with respect to the grip 12, and the space between the gripping pieces 16 and 17 is closed.
  • the treatment target is gripped between the gripping pieces 16 and 17.
  • FIG. 7 is a view showing a state in which the housing 2 of the treatment instrument 1 is held by one hand (left hand in FIG. 7) H0.
  • FIG. 7 is a view seen from one side (arrow W1 side) in the width direction of the housing 2.
  • FIG. 7 shows a state where the index finger F2 is in contact with one recess (one of 36).
  • FIG. 8 shows the rotary member 25 in a state in which the index finger F2 is in contact with the rotary member (rotary knob) 25 in a cross section substantially parallel to a predetermined rotation axis R (longitudinal axis C).
  • R longitudinal axis C
  • the index finger F ⁇ b> 2 in contact with one protrusion (one of 35) in the rotating member 25 is indicated by a broken line, and one recess (one of 36) in the rotating member 25.
  • the index finger F2 in a state of being in contact with is indicated by a solid line.
  • each of the operation buttons 27A and 27B is pressed by the middle finger F3, and an operation at each of the operation buttons 27A and 27B is input by the middle finger F3.
  • the operation button (27A or 27B) is provided on the outer surface of the housing 2 at a portion facing one side in the width direction, an operation with the operation button (27A or 27B) is input by the thumb F1.
  • the finger pad A1 (distal interphalangeal (DIP) of the index finger F2 is placed on one of the protrusions 35 of the rotating member 25. joint) A part on the fingertip side from J1 is brought into contact. Then, an operating force for rotating the rotating member 25 about a predetermined rotation axis R (about the longitudinal axis C) is applied with the ball A1 of the index finger F2 of the rotating member 25. As a result, the shaft 3 and the end effector 5 rotate around the predetermined rotation axis R with respect to the housing 2 together with the rotating member 25. At this time, the index finger F2 extends substantially straight without bending at the distal interphalangeal joint (first joint) J1 or the like.
  • each of the first inclined surfaces 45 extends from the distal end portion of the corresponding projection (corresponding one of 35) toward the distal end side, and each of the first inclined surfaces 45.
  • the first inclination angle (acute angle) ⁇ 1 with respect to the predetermined rotation axis R is small. For this reason, when the rotating member 25 is rotated about the predetermined rotation axis R, the rotation member 25 is adjacently provided around the predetermined rotation axis R from the protrusion (one of 35) with which the finger pad A1 of the index finger F2 is in contact. It is easy to move the finger pad A1 to the projection (one corresponding to 35). For this reason, the operativity which rotates the rotation member 25 improves.
  • a force may act on the end effector 5 in a state where the end effector 5 is bent with respect to the shaft 3 (predetermined rotation axis R).
  • a force acts on the end effector 5 at a position away from the center axis (predetermined rotation axis R) of the shaft 3
  • the force acting on the end effector 5 causes a rotation around the predetermined rotation axis R (the center of the shaft 3).
  • a rotational moment may occur around the axis.
  • each of the protrusions 35 protrudes to the outer peripheral side with respect to the defining surface 41.
  • Each of the recesses 36 is continuous with the corresponding one end side of the protrusion 35 and is recessed toward the inner peripheral side with respect to the defining surface 41. For this reason, in a state where the index finger F2 is in contact with a certain recess (one of 36), the finger pad A1 is closer to the proximal side than the distal interphalangeal joint J1 in the distal interphalangeal joint J1 of the index finger F2. Bent to the inner peripheral side of the rotating member 25 with respect to the part.
  • the rotation member 25 is connected to the distal end side of the housing body 11, and the grip 12 is provided at a part away from a predetermined rotation axis R (longitudinal axis C). .
  • the force application unit 22 is positioned on the side where the grip 12 is positioned with respect to the predetermined rotation axis R (longitudinal axis C) and on the tip side with respect to the grip 12. Therefore, when the housing 2 is held by one hand H0 and the finger pad A1 of the index finger F2 is in contact with the recess (one of 36), it intersects the predetermined rotation axis R.
  • the index finger F2 When viewed from one side (the arrow W1 side or the arrow W2 side) in the direction intersecting with the extending direction of the grip 12 (the direction indicated by the arrows Y1 and Y2), the index finger F2 has a predetermined rotation axis R ( Inclined with respect to the longitudinal axis C).
  • the rotation is inclined with respect to the rotation axis R when viewed from one side in the width direction of the housing 2.
  • the finger pad A1 is brought into contact with a certain recess (one of 36).
  • the finger pad A1 bends to the inner peripheral side of the rotating member 25 at the distal interphalangeal joint (first joint) J1 of the index finger F2.
  • the rotating member When the index finger F2 is bent, the rotating member has a suppression force that suppresses the rotation of the shaft 3 and the end effector 5 due to the rotational moment as compared to a state where the index finger F2 is not bent (a state where the index finger F2 is extended substantially straight). 25 is easy to apply.
  • the suppressing force that acts on the rotating member 25 from the index finger F2 in the direction opposite to the rotational moment is exerted. growing.
  • the finger pad A1 faces the proximal end side. Extended. Then, the distal interphalangeal joint J1 of the index finger F2 or the vicinity thereof (for example, the base side portion of the finger pad A1) contacts one of the protrusions 35.
  • a recess (corresponding one of 36) that is continuous with the tip side of the protrusion (corresponding one of 35) with which the distal interphalangeal joint J1 or its vicinity abuts is a recess with which the fingertip side portion of the finger pad A1 abuts.
  • the protrusions (the corresponding one of 35) with which the end portion abuts are adjacent to each other.
  • each of the recesses 36 is formed in a shape into which the finger pad A2 of the index finger F2 fits. For this reason, the state in which the finger pad A1 is bent at the distal interphalangeal joint J1 is easily maintained by fitting into a recess (one of 36) where the fingertip side portion of the finger pad A1 of the index finger F2 is located.
  • each of the 2nd inclined surface 46 continues to the front end side of a corresponding 1st inclined surface (one corresponding
  • the second inclination angle (acute angle) ⁇ 2 of each of the second inclined surfaces 46 with respect to the predetermined rotation axis R is large and close to 90 °. Since the second inclination angle ⁇ 2 is large, the recess of the recess 36 from the defining surface 41 is increased, and the radial direction between each of the protrusions 35 and the recess (corresponding one of 36) continuous on the tip side thereof. The step (the corresponding one of 38) is also increased. Thereby, the fingertip side portion of the finger pad A1 of the index finger F2 is likely to fit into the recess 36.
  • the plurality of recesses 36 are arranged symmetrically about the predetermined rotation axis R, at least one recess (36) can be used regardless of the angular position of the end effector 5 about the predetermined rotation axis R. Is located at a position where the finger pad A1 of the index finger F2 is easy to fit.
  • a force toward the proximal end is applied from the finger pad A1 to the rotating member 25 in a state where the finger pad A1 of the index finger F2 is in contact with a certain recess (one of 36).
  • a force is applied to the step (one corresponding to 38) on the proximal end side of the recess (one of 36) into which the finger pad A1 is fitted.
  • the palm H1 and the thumb F1 come into contact with the grip 12 from the proximal end side, so that a pressing force acts on the housing 2 from the palm H1 toward the distal end side.
  • a force is applied from the finger pad A1 to the rotating member 25 in the width direction of the housing 2 while the finger pad A1 of the index finger F2 is in contact with a certain recess (one of 36).
  • the first facing surface (47) and the second facing surface (48) may be brought into contact with each other.
  • Friction occurs between the first facing surface (47) and the second facing surface (48).
  • each of the protrusions 35 and recesses 36 may be nine or more, or may be seven or less. Further, only one protrusion 35 and one recess 36 may be provided. However, in any case, the number of the protrusions 35 and the number of the recesses 36 are the same, and each of the recesses 36 is continuous with the corresponding one tip side in the protrusion 35.
  • the recess 36 does not need to be provided on the rotating member 25.
  • the housing 2 is provided with recesses (two in this modification) that are recessed toward the inner periphery.
  • the rotation member 25 is attached to the housing body 11, and the housing body 11 extends along the rotation member 25 and a predetermined rotation axis R (longitudinal axis C) of the shaft 3.
  • the housing main body 11 includes a front end side outer surface 61 provided on the front end side with respect to the rotating member 25, and the housing main body 11 extends also in a portion on the front end side from the front end of the rotating member 25. Is done.
  • Each of the recesses 36 is recessed inward on the distal end side outer surface 61.
  • one of the recesses 36 is provided in a portion facing the one side in the width direction (arrow W1 side) on the distal end side outer surface 61, and the other of the recesses 36 is disposed in the width direction on the distal end side outer surface 61. Is provided at a portion facing the other side (arrow W2 side).
  • each of the recessed part 36 is formed in the shape where the fingertip side part of finger pad A1 of the index finger F2 fits.
  • the grip 12 and the handle 21 are provided as in the first embodiment, and the installation surface 28 facing the tip side is provided between the force applying unit 22 of the handle 21 and the rotating member 25. Then, the operation button 27 ⁇ / b> A is installed on the installation surface 28.
  • the rotating member 25 is provided with a plurality of protrusions 35, and a defining surface 41 that defines the root (Q1) of the protrusion 35 is provided. And in the cross section substantially perpendicular to the predetermined rotation axis R passing through the protrusion 35, the protrusions 35 and the valleys 42 are alternately arranged around the predetermined rotation axis R (around the longitudinal axis C).
  • the concave portion 36 is provided on the distal end side outer surface 61, each of the concave portions 36 is provided on the distal end side of the protrusion 2 in the housing 2.
  • the recessed part 36 has shifted
  • each of the protrusions 35 protrudes toward the outer peripheral side with respect to the defining surface 41 and the front end side outer surface 61 of the housing 2, and each of the concave portions 36 is recessed toward the inner peripheral side at the front end side outer surface 61.
  • the finger joint A1 is the distal interphalangeal joint at the distal interphalangeal joint J1 of the index finger F2. Bends toward the inner peripheral side of the rotary member 25 with respect to the base side portion from J1.
  • the distance from the tip of the rotating member 25 (tip of the projection 35) to each of the recesses 36 is not excessively large.
  • the finger of the index finger F2 is bent from the state in which the finger pad A1 of the index finger F2 contacts the projection (one of 35) to the inner peripheral side at the distal interphalangeal joint J1.
  • the abdomen A1 contacts the recess (one of 36). That is, at least one of the recesses 36 is located in a range in which the index finger F2 can come into contact with the housing 2 held by the hand H0.
  • the finger pad A1 of the index finger F2 is fitted in one of the recesses 36, and the fingertip side portion of the finger pad A1 is in contact with the recess (one of 36),
  • the distal interphalangeal joint (first joint) J1 of the index finger F1 or the vicinity thereof contacts one of the protrusions 35 of the rotating member 25.
  • the treatment instrument in which the rotational moment is generated around the predetermined rotation axis R by the force acting on the end effector 5 is not limited to the treatment instrument 1 provided with the bending joint 18 as in the above-described embodiment.
  • a bending portion 50 may be provided on the distal end side with respect to the shaft 3 instead of the bending joint 18.
  • a plurality of bending pieces 51 are arranged in parallel, and each of the bending pieces 51 is rotatably connected to an adjacent bending piece (one or two corresponding to 51).
  • a bending operation input portion is provided in the housing 2, and the bending portion 50 is operated by an operation at the bending operation input portion.
  • the end effector 5 including the bending portion 50 is bent with respect to the shaft 3 (predetermined rotation axis R). Since the force is applied to the end effector 5 in a state where the end effector 5 is curved with respect to the shaft 3, the force is applied to a position away from the predetermined rotation axis R as described above. There is a possibility that a rotational moment is generated (around the central axis of the shaft 3).
  • the end effector 5 protrudes from the tip of the shaft 3 toward the tip, and the end effector 5 extends in a state of bending with respect to the shaft 3 (predetermined rotation axis R).
  • a curved extending portion 55 is provided.
  • a force is applied to a position away from the predetermined rotation axis R as described above due to the force acting on the distal end side of the curved extending portion 55.
  • a rotational moment is generated around the central axis of 3.
  • a pair of grip pieces 16 and 17 are provided on the end effector 5 as in the first embodiment.
  • none of the bending joint (18), the bending portion (50), and the bending extending portion (55) is provided in the treatment instrument 1.
  • the treatment may be performed in a state where the gripping pieces 16 and 17 are open. In a state in which the gap between the gripping pieces 16 and 17 is open, for example, a force acts on a gripping piece (for example, the second gripping piece 17) that is rotatably attached to the shaft 3.
  • the treatment instrument (1) includes a housing (2) that can be held, a shaft (3) that can rotate about a predetermined rotation axis (R) with respect to the housing (2), and a shaft ( And 3) an end effector (5) provided at the tip, and a rotating member (25) that rotates about a predetermined rotation axis (R) together with the shaft (3) and the end effector (5).
  • the rotating member (25) includes a protrusion (35) that protrudes from the outer peripheral side and extends from the proximal end side to the distal end side.
  • the treatment instrument (1) includes a recess (36) that is recessed on the inner peripheral side, and the recess (36) is continuous with the distal end side of the protrusion (35) in the rotating member (25) or in the housing (2). Provided on the tip side from the protrusion (35).

Abstract

Afin d'éliminer efficacement la rotation d'un effecteur terminal (5) et d'un arbre (3), ladite rotation étant provoquée par une force appliquée à l'effecteur terminal (5), l'invention concerne un outil de traitement qui est pourvu d'un élément rotatif (25) qui tourne, avec l'arbre et l'effecteur terminal, autour d'un axe de rotation prédéterminé par rapport à un boîtier. L'élément rotatif (25) est pourvu d'une saillie (35) qui s'étend du côté d'extrémité de base jusqu'au côté d'extrémité avant en saillant vers le côté périphérique externe. L'élément rotatif est également pourvu d'une section évidée (36) continue jusqu'au côté d'extrémité avant de la saillie, ou d'une section évidée (36) qui se trouve plus loin que la saillie vers le côté d'extrémité avant du boîtier.
PCT/JP2016/066261 2016-06-01 2016-06-01 Outil de traitement WO2017208399A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
PCT/JP2016/066261 WO2017208399A1 (fr) 2016-06-01 2016-06-01 Outil de traitement
US16/196,977 US20190083119A1 (en) 2016-06-01 2018-11-20 Treatment tool

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2016/066261 WO2017208399A1 (fr) 2016-06-01 2016-06-01 Outil de traitement

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US16/196,977 Continuation US20190083119A1 (en) 2016-06-01 2018-11-20 Treatment tool

Publications (1)

Publication Number Publication Date
WO2017208399A1 true WO2017208399A1 (fr) 2017-12-07

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Application Number Title Priority Date Filing Date
PCT/JP2016/066261 WO2017208399A1 (fr) 2016-06-01 2016-06-01 Outil de traitement

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US (1) US20190083119A1 (fr)
WO (1) WO2017208399A1 (fr)

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2015122353A1 (fr) * 2014-02-12 2015-08-20 オリンパス株式会社 Instrument de traitement
JP2016500536A (ja) * 2012-10-22 2016-01-14 エシコン・エンド−サージェリィ・インコーポレイテッドＥｔｈｉｃｏｎ Ｅｎｄｏ−Ｓｕｒｇｅｒｙ，Ｉｎｃ． 外科用器具のための可撓性高調波導波管／ブレード

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Publication number Priority date Publication date Assignee Title
US8834466B2 (en) * 2010-07-08 2014-09-16 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an articulatable end effector
US8679098B2 (en) * 2011-09-13 2014-03-25 Covidien Lp Rotation knobs for surgical instruments
US9549749B2 (en) * 2012-10-08 2017-01-24 Covidien Lp Surgical forceps
US10159506B2 (en) * 2015-03-16 2018-12-25 Ethicon Llc Methods and devices for actuating surgical instruments

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2016500536A (ja) * 2012-10-22 2016-01-14 エシコン・エンド−サージェリィ・インコーポレイテッドＥｔｈｉｃｏｎ Ｅｎｄｏ−Ｓｕｒｇｅｒｙ，Ｉｎｃ． 外科用器具のための可撓性高調波導波管／ブレード
WO2015122353A1 (fr) * 2014-02-12 2015-08-20 オリンパス株式会社 Instrument de traitement

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